Exercise Therapy Research Articles

The applied study to improve the treatment of knee sports injuries in ultimate frisbee players based on personalized exercise prescription: a randomized controlled trial.

Ultimate frisbee can lead to severe sports injuries, especially joint injuries in the lower limbs, such as knee meniscus injuries. This study examines the impact of personalized exercise therapy on knee meniscus injuries in ultimate frisbee players in the Lingnan region of China. Seventy-six patients with confirmed meniscal injuries participated in the study, divided into an intervention group (n = 38) and a control group (n = 38). The control group received standard treatment, including drug therapy and physical therapy. The intervention group received standard treatment plus a personalized exercise regimen based on FITT-VP (frequency, intensity, time, type, volume, and progression) principles, incorporating strength training, aerobic exercise, flexibility training, neuromuscular training, and aquatic exercise. This program was monitored and adjusted over a six-month period through both online and offline methods. The primary outcomes were joint range of motion (ROM), thigh circumference atrophy index (TCAI), Lysholm Rating Scale (LRS) scores, and visual analog scores (VAS). The secondary outcome was the International Knee Documentation Committee (IKDC) score. Data were collected before the intervention, and at 1 month and 6 months after the intervention. Statistical analysis was conducted using SPSS 24.0 and GraphPad 10.0, with a significance level set at α = 0.05. After 1 month, the intervention group showed significantly better results in ROM (116.67 ± 9.063), LRS score (86.316 ± 3.750), and IKDC score (80.473 ± 5.421) compared to the control group (111.784 ± 4.778, 82.579 ± 3.818, and 77.684 ± 4.430, respectively) (p < 0.05). The TCAI (3.219 ± 1.889) and VAS score (1.921 ± 0.673) in the intervention group were significantly lower than those in the control group (5.228 ± 2.131 and 2.710 ± 1.112, respectively) (p < 0.01). After 6 months, the differences in LRS and VAS scores between the groups were not significant. However, the intervention group continued to show significant improvements in ROM (134.934 ± 3.011), TCAI (1.107 ± 1.158), and IKDC score (93.315 ± 1.847) compared to the control group (125.395 ± 18.554, 4.574 ± 1.109, and 87.789 ± 4.437, respectively) (p < 0.05). Personalized exercise prescriptions offer significant therapeutic and rehabilitative benefits for ultimate frisbee players with knee meniscus injuries. This approach helps to reduce symptoms, alleviate pain, and improve joint function, muscle strength, and athletic performance after sports-related injuries.

Effect of Combined Exercise and Nutrition Interventions During Inpatient Chemotherapy in Acute Leukemia and Malignant Lymphoma Patients: A Randomized Controlled Trial

The aim of the present study was to determine the effectiveness of combined exercise and nutrition interventions on physical function and quality of life (QOL) in patients with acute leukemia or malignant lymphoma (ML) during inpatient chemotherapy. The study was a randomized controlled trial where patients with acute leukemia or ML who were receiving inpatient chemotherapy and exercise therapy were divided into an intervention group (IG) and a control group (CG). Both groups underwent resistance training and aerobic exercise. The patients in the IG were instructed to take nutritional supplements twice a day. Assessment items were muscle strength (handgrip strength and knee extension strength), 6-min walking test, skeletal muscle mass, QOL, nutritional status, and fatigue. Two-way analysis of variance showed a significant interaction for bilateral handgrip strength and knee extension strength. No significant interactions were found for the other items. The results of the present study showed improved muscle strength in the IG compared to the CG, indicating the effectiveness of combined exercise and nutrition interventions during inpatient chemotherapy in patients with acute leukemia or ML.

The effect of music therapy and breathing exercise on anxiety and pain in patients undergoing coronary angiography: A randomized controlled study.

For over 50 years, music therapy and breathing exercises have been widely utilized as interventions to help individuals cope with fatigue, stress and pain globally. To analyse the effects of music and breathing exercises on anxiety and pain in patients undergoing coronary angiography. This is a single-blind, randomized controlled trial. The sample comprised 165 patients: 55 in the control group, 55 in the breathing exercise group and 55 in the music therapy group. Patients in the music group listened to music during angiography, those in the breathing exercise group practised exercises 30 min before the procedure and the control group received standard treatment. Anxiety levels were assessed before and after the procedure, and pain levels were measured post-procedure. The Consolidated Standards of Reporting Trials (CONSORT) checklist for reporting randomized trials was used to guide reporting. Anxiety scores rose significantly in the control group from 33.9 ± 4.2 pre-angiography to 37.7 ± 4.9 post-angiography. Conversely, the breathing group's anxiety scores decreased from 34.3 ± 3.5 before angiography to 31.7 ± 1.5 after angiography, and the music group exhibited a reduction from 32.3 ± 3.6 to 30.8 ± 1.6. Post-angiography, the control group reported a mean pain score of 64 ± 0.8 mm, while the breathing and music groups had significantly lower scores of 35 ± 0.6 and 29 ± 0.8 mm, respectively. Statistical analysis showed a highly significant difference in pain scores between the intervention and control groups. This study provides support for the beneficial effects of employing breathing exercises and music in alleviating pain and anxiety during coronary angiography procedures. Integrating these findings into clinical practice could be significant for improving patients' pain experiences and anxiety, enhancing the tolerance of invasive medical procedures.

Does Vitamin B6 Act as an Exercise Mimetic in Skeletal Muscle?

Marginal vitamin B6 (B6) deficiency is common in various segments worldwide. In a super-aged society, sarcopenia is a major concern and has gained significant research attention focused on healthy aging. To date, the primary interventions for sarcopenia have been physical exercise therapy. Recent evidence suggests that inadequate B6 status is associated with an increased risk of sarcopenia and mortality among older adults. Our previous study showed that B6 supplementation to a marginal B6-deficient diet up-regulated the expression of various exercise-induced genes in the skeletal muscle of rodents. Notably, a supplemental B6-to-B6-deficient diet stimulates satellite cell-mediated myogenesis in rodents, mirroring the effects of physical exercise. These findings suggest the potential role of B6 as an exercise-mimetic nutrient in skeletal muscle. To test this hypothesis, we reviewed relevant literature and compared the roles of B6 and exercise in muscles. Here, we provide several pieces of evidence supporting this hypothesis and discuss the potential mechanisms behind the similarities between the effects of B6 and exercise on muscle. This research, for the first time, provides insight into the exercise-mimetic roles of B6 in skeletal muscle.

Ultrasound and Doppler Study in Assessing the Efficiency of Complex Rehabilitation in Patients with Diabetic Neuropathy

The aim of the work: to evaluate the effectiveness of exercise therapy, ozone therapy, physiotherapy equipment in outpatient rehabilitation and treatment of patients with diabetic neuropathy of the lower extremities from the standpoint of the International Classification of Functioning, Disability, and Health. When evaluating the effectiveness of a monthly course of rehabilitation treatment, changes in the vessels of the lower extremities are of great importance. We were able to prove a positive change in the vessels of the lower extremities after treatment with the rehabilitation complex using ultrasound Dopplerography. In the main group, an increase in the blood flow velocity in the vessels of the lower extremities by 20.5% was noted, and in the comparison group, an increase in the blood flow velocity of the lower extremities by 12.7% was noted. The effectiveness of rehabilitation was assessed based on a comparison of the achieved rehabilitation results with the initial indicators.

Non-pharmacological interventions to treat mood disturbances post-stroke: a systematic review

ABSTRACT Background Stroke survivors face high rates of depression, anxiety, and pseudobulbar affect. Clinicians report lack of clarity on effective non-pharmacological interventions due to uncertainty about treatment options as barriers to evidence-based treatment. No systematic review has investigated the effectiveness of non-pharmacological interventions on the conditions of depression, anxiety, and pseudo-bulbar affect. Objectives The aim of this study was to evaluate the effectiveness of non-pharmacological interventions on the outcomes of depression, anxiety, and pseudobulbar affect in post-stroke individuals. Methods Following the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched databases Medline, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO for randomized controlled trials in English, within 2012–2023, evaluating the effect of a non-pharmacological intervention on depression, anxiety, and/or pseudobulbar affect. Two researchers screened titles, abstracts, and full texts. One researcher extracted data and assessed risk of bias. Data were synthesized narratively. Results Forty-two studies were included. Intervention types included education (n = 9), psychological therapy (n = 8), and physical exercise (n = 8). Intervention types reporting positive outcomes for depression were psychological therapy (n = 6), physical exercise (n = 3) and robot-assisted therapy (n = 3). Intervention types effective in improving anxiety were physical exercise (n = 2), psychological therapy (n = 3) and multi-modal therapy approaches (n = 2). No studies explored the impact on pseudobulbar affect. Conclusion Non-pharmacological interventions may be effective in improving mood in stroke survivors. Robot-assisted therapy and physical exercise were seen to improve multiple outcome measures. Patient education should be delivered alongside rehabilitation and directed to both stroke-survivor and caregiver.

Manual therapy plus sexual advice compared with manual therapy or exercise therapy alone for lumbar radiculopathy: a randomized controlled trial.

The biopsychosocial approach to managing low back pain (LBP) has the potential to improve the quality of care for patients. However, LBP trials that have utilized the biopsychosocial approach to treatment have largely neglected sexual activity, which is an important social component of individuals with LBP. The objectives of the study are to determine the effects of manual therapy plus sexual advice (MT+SA) compared with manual therapy (MT) or exercise therapy (ET) alone in the management of individuals with lumbar disc herniation with radiculopathy (DHR) and to determine the best sexual positions for these individuals. This was a single-blind randomized controlled trial. Fifty-four participants diagnosed as having chronic DHR (>3 months) were randomly allocated into three groups with 18 participants each in the MT+SA, MT and ET groups. The participants in the MT+SA group received manual therapy (including Dowling's progressive inhibition of neuromuscular structures and Mulligan's spinal mobilization with leg movement) plus sexual advice, those in the MT group received manual therapy only and those in the ET group received exercise therapy only. Each group received treatment for 12 weeks and then followed up for additional 40 weeks. The primary outcomes were pain, activity limitation, sexual disability and kinesiophobia at 12 weeks post-randomization. The MT+SA group improved significantly better than the MT or ET group in all outcomes (except for nerve function), and at all timelines (6, 12, 26, and 52 weeks post-randomization). These improvements were also clinically meaningful for back pain, leg pain, medication intake, and functional mobility at 6 and 12 weeks post-randomization and for sexual disability, activity limitation, pain catastrophizing, and kinesiophobia at 6, 12, 26, and 52 weeks post-randomization (p<0.05). On the other hand, many preferred sexual positions for individuals with DHR emerged, with "side-lying" being the most practiced sexual position and "standing" being the least practiced sexual position by females. While "lying supine" was the most practiced sexual position and "sitting on a chair" was the least practiced sexual position by males. This study found that individuals with DHR demonstrated better improvements in all outcomes when treated with MT+SA than when treated with MT or ET alone. These improvements were also clinically meaningful for sexual disability, activity limitation, pain catastrophizing, and kinesiophobia at long-term follow-up. There is also no one-size-fits-all to sexual positioning for individuals with DHR.

A national survey of current rehabilitation service provisions for people living with chronic kidney disease in the UK: implications for policy and practice

BackgroundNational guidance recognises the key role of rehabilitation in improving outcomes for people living with chronic kidney disease. Implementation of this guidance is reliant upon an adequate and skilled rehabilitation workforce. Data relating to this is currently lacking within the UK. This survey aimed to identify variations and good practices in kidney physiotherapy (PT), occupational therapy (OT) and clinical exercise physiologist (CEP) provision; and to understand barriers to implementation.MethodsAn online survey was sent to all 87 UK kidney units between June 2022 and January 2023. Data was collected on the provision of therapy services, barriers to service provision and responses to the COVID-19 pandemic. The quantitative survey was analysed using descriptive statistics. Free-text responses were explored using reflexive thematic analysis.ResultsForty-five units (52%) responded. Seventeen (38%) units reported having a PT and 15 (33%) an OT with a specialist kidney role; one unit (7%) had access to a CEP. Thirty units (67%) offered inpatient therapy services, ten (22%) outpatient therapy clinics, six (13%) intradialytic exercise, six (13%) symptom management and three (7%) outpatient rehabilitation. Qualitative data revealed lack of money/funding and time (both n = 35, 85% and n = 34, 83% respectively) were the main barriers to delivering kidney-specific therapy. Responders saw an increase in the complexity of their caseload, a reduction in staffing levels and consequently, service provision during the COVID-19 pandemic. Exemplars of innovative service delivery, including hybrid digital and remote services, were viewed as positive responses to the COVID-19 pandemic.ConclusionDespite clear evidence of the benefits of rehabilitation, across the UK, there remains limited and variable access to kidney-specific therapy services. Equitable access to kidney-specific rehabilitation services is urgently required to support people to ‘live well’ with kidney disease.

Comparing the efficacy of exercise therapy on adult flexible flatfoot individuals through a network meta-analysis of randomized controlled trials

The aim of this study is to compare the efficacy of different exercise interventions for adult flexible flatfoot. Nine databases (PubMed, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), SCOPUS, PRDro, Google Scholar, China National Knowledge Infrastructure(CNKI) and Wanfang data) were systematically searched from their inception until February 2024. The search resulted in 2112 records, with 11 studies included. All networks revealed low heterogeneity and non-significant inconsistency (I2 ≤ 25.0%). Three network plots were formed for navicular drop. Firstly, compared with the control group, strengthening the posterior tibial muscle + stretching the iliopsoas muscle + TCE (MD: 3.32, 95% CI: 1.78, 4.89), PNF (MD: 1.81, 95%CI: -0.05, 3.70), SFE (MD: 1.23, 95%CI: 1.02, 1.44) all showed better effects. And strengthening the posterior tibial muscle + stretching the iliopsoas muscle + TCE exercise is considered to be the most effective intervention, with SUCRA of 0.97. Secondly, compared with the control group, hip-focused neuromuscular exercise (MD: 6.22, 95% CI: -1.69, 14.12), SFE with EMG biofeedback (MD: -0.81, 95%CI: -1.59, 3.21) all showed better effects. And hip-focused neuromuscular exercise is considered to be the most effective intervention, with SUCRA of 0.92. Thirdly, the internal foot muscle training combined with gluteus muscle strengthening is significantly better than the other two groups, with SUCRA of 0.99. For the foot posture index, comprehensive reinforcement (MD: 1.95, 95% CI − 0.19, 4.03) showed better effects compared with the control group. In the probability ranking table, comprehensive reinforcement is significantly better than the other two groups, with SUCRA of 0.98. For the foot function index, orthoses wear + stretching + eccentric progressive resistive exercise of tibialis posterior is significantly better than the other two groups, with SUCRA of 0.92. In conclusion, various exercise therapies improve the arch shape and function of patients with flexible flatfoot, particularly hip muscle and lower limb overall muscle training.

The Effectiveness of Electrical Stimulation Along with Ultrasound Therapy and Elastic Band Exercise on Muscle Strength and Functional Ability in Athletes with Sub-Acute Rotator Cuff Tendinitis

The Effectiveness of Electrical Stimulation Along with Ultrasound Therapy and Elastic Band Exercise on Muscle Strength and Functional Ability in Athletes with Sub-Acute Rotator Cuff Tendinitis

Exercise for patients with arthritis

Background: Osteoarthritis and rheumatoid arthritis are major causes of pain and disability globally, and exercise is known to be effective at alleviating symptoms and improving physical function.Current Concepts: Knee osteoarthritis is a common degenerative disease, and comprehensive clinical practice guidelines have been established. Most studies strongly recommend appropriate weight management combined with exercise therapy. Aerobic, strength, resistance, isometric, neuromuscular, and balance training have been used. However, the current evidence is insufficient to recommend specific prescriptions regarding the exercise type and dose. Many guidelines group knee and hip osteoarthritis together for exercise recommendations. Evidence supporting the use of exercise for hand osteoarthritis is relatively scarce, and reports on its adverse effects are rare. Weight loss is not recommended for hand osteoarthritis, because its effectiveness has not yet been established. For patients with polyarticular osteoarthritis, exercise is recommended as a core treatment, with systematic land-based exercises being particularly advised. For rheumatoid arthritis, both general exercises and hydrotherapy are recommended to improve joint flexibility, muscle strength, and functional outcomes.Discussion and Conclusion: Exercise is a powerful treatment tool for various types of arthritis. However, further research is required to develop more specific exercise intervention protocols.

Clinical practice guidelines and expert consensus statements on rehabilitation for patients with COVID-19: a systematic review

ObjectivesTo appraise the quality of clinical practice guidelines (CPGs) and expert consensus statements on rehabilitation for patients with COVID-19, summarise recommendations of rehabilitation assessments and interventions and evaluate the heterogeneity...

New-onset hydrocephalus in an adult with cerebral palsy: A case report and review of the literature.

Hydrocephalus is a common comorbidity associated with brain injuries, including cerebral palsy (CP). In CP, hydrocephalus typically presents in infancy or early childhood. This report describes a patient in their mid 20 s with mixed dyskinetic-spastic CP with adult-onset hydrocephalus of unknown cause initially presenting with new-onset bilateral lower extremity spasms. Multiple interventions were trialed, including ischial bursal steroid injections, botulinum toxin injections, trigger point injections, multiple oral medications, and physical and massage therapies without benefit. Given lack of treatment response, imaging of the neuraxis was obtained. Magnetic resonance imaging (MRI) of the brain demonstrated new diffuse moderate ventriculomegaly compared to prior MRI. Ophthalmologic evaluation demonstrated papilledema, and opening pressure on lumbar puncture was elevated to 44 mmHg H2O. The patient underwent ventriculoperitoneal shunt placement with rapid and near-resolution of their spasms and pain. This patient represents a unique case of new-onset hydrocephalus in an adult with CP. To ensure appropriate and timely diagnosis and treatment, individuals with neurologic conditions such as CP should have ongoing surveillance and comprehensive evaluation for any neurologic or functional changes, including changes in baseline tone. Future research is needed to better understand if adults with CP are at higher risk for the development of hydrocephalus in adulthood.

Exercise for patients with neuromuscular diseases

Background: Neuromuscular diseases (NMD) vary widely with regard to their onset, progression, and symptoms, which include muscle weakness, sensory loss, pain, fatigue, and joint contractures. Owing to this diversity, creation of a unified exercise therapy approach is challenging.Current Concepts: Exercise recommendations for patients with NMD prioritize maintenance of patients’ current functional status, prevention of further decline, and provision of compensatory training. Conventionally, highintensity exercises are not recommended owing to the risks of overwork weakness and muscle injury. Recent studies indicate that tailored aerobic exercises can improve endurance, cardiovascular function, and overall health without worsening muscle injury. Flexibility exercises are essential to prevent joint contractures. Resistance training should focus on avoidance of high-intensity and eccentric exercises and on maintenance of rather than an increase in muscle strength.Discussion and Conclusion: Evidence regarding the benefits of exercise in patients with NMD is inconsistent. Aerobic exercise is usually safe and may help maintain function and increase maximal oxygen uptake; however, low-intensity exercise is preferred to avoid fatigue and muscle injury. Resistance training may help preserve muscle strength in some patients; however, high-intensity workouts are not should be avoided to mitigate the risk of muscle overload and injury. Tailored exercise programs designed according to disease characteristics are essential.. Further well-designed, large-scale studies are necessary to establish effective and safe exercise guidelines for patients with NMD.

Exercise is medicine: how should medicine embrace exercise as a key therapeutic tool?

Background: As chronic diseases and the aging population increase, exercise is becoming more and more essential along with medical treatment for recovering and maintaining individuals’ physical health. Furthermore, the demand for exercise-based interventions in this context is growing. Although most healthcare professionals recognize the effectiveness and necessity of exercise, the “Exercise is Medicine” initiative has not been established in clinical settings. We aim to discuss the effectiveness and importance of exercise in the treatment and management of diseases and how exercise should be considered a key therapeutic tool in medicine.Current Concepts: Exercise-related mechanisms and their influence on body structure and function should be considered in disease management. It is necessary to understand these interactions and monitor their effects on the entire body. During recovery after an injury, exercise rehabilitation is provided as program customized according to the phase and function levels, the clinical pathway of which is feasible and effective. Exercise programs for maintaining the functioning and physical and mental health of people with disabilities should be developed by considering individuals’ functional levels, disability types, and conditions. Correct posture, microbreaks, and regular exercise are key to managing musculoskeletal pain.Discussion and Conclusion: To ensure the effectiveness of the “Exercise is Medicine” initiative, exercise should be included in the National Health Insurance System after clarifying the indications and clinical effectiveness of exercise therapy and defining specific procedures. Furthermore, increased awareness and changes in the attitude of healthcare professionals and patients toward exercise are necessary. It is now time for the medical community to ponder over and pool its wisdom on how to adopt exercise as a key therapeutic tool.

Effects of a structured exercise therapy on health-related quality of life in pediatric stem cell transplantation

IntroductionThis randomized controlled trial investigated the effects of exercise therapy on cancer-related fatigue (CRF) and its association with health-related quality of life. The effect of exercise therapy on the quality of life of children after stem cell transplantation has not been extensively studied to date.MethodsSeventy-two children and adolescents after stem cell transplantation were randomly assigned to either an exercise therapy intervention group (IG) or a control group (CG). The children in IG received sports therapy, while the children in the CG engaged in concentration tasks, memory games, and quizzes.ResultsSignificant improvements in CRF were found in IG only after discharge from the hospital. The improved CRF correlated significantly with increased health-related quality of life. However, during the inpatient phase, there was a rapid increase in CRF initially, which was accompanied by a significant reduction in health-related quality of life.ConclusionsExercise therapy can help reduce CRF and, therefore, increase health-related quality of life after the inpatient phase.

Efficacy of the mHealth-Based Exercise Intervention re.flex for Patients With Knee Osteoarthritis: Pilot Randomized Controlled Trial.

Exercise therapy is recommended by international guidelines as a core treatment for patients with knee osteoarthritis. However, there is a significant gap between recommendations and practice in health care. Digital exercise apps are promising to help solve this undersupply. This study aims to evaluate the efficacy of a 12-week fully automated app-based exercise intervention with and without a supporting knee brace on health-related outcomes, performance measures, and adherence in patients with knee osteoarthritis. This closed user group trial included participants with moderate to severe unicondylar painful knee osteoarthritis. Randomization was 1:1:2 into an intervention group (IG) with 2 subgroups (app-based training [IG A] and app-based training and a supportive knee brace [IG AB]) and a control group (CG). The intervention included a 12-week home exercise program with 3 sessions per week. Instructions for the exercises were given via the app and monitored using 2 accelerometers placed below and above the affected knee joint. Participants in the CG did not receive any study intervention but were allowed to make use of usual care. Osteoarthritis-specific pain (Knee Injury and Osteoarthritis Outcome Score) was defined as the primary outcome, and secondary outcomes included all other Knee Injury and Osteoarthritis Outcome Score subscales, general health-related quality of life (Veterans RAND 12-item Health Survey), psychological measures (eg, exercise self-efficacy), performance measures (strength and postural control), and the monitoring of adherence and safety. Outcomes were assessed at baseline and after 12 weeks. Intervention effects were calculated using baseline-adjusted analysis of covariance for the joint comparison of IG A and IG AB versus the CG using a per-protocol approach. Subgroup analyses were conducted for each IG separately. A total of 61 participants were included (IG: n=30, 49%; CG: n=31, 51%; male: n=31, 51%; female: n=30, 49%; mean age 62.9, SD 8.5 years; mean BMI 27.7, SD 4.5 kg/m2). Analysis revealed statistically significant effects in favor of the IG for pain reduction (P<.001; effect size [ES]=0.76), improvements in physical function (P<.001; ES=0.64), improvements in symptoms (P=.01; ES=0.53), improvements in sport and recreation activities (P=.02; ES=0.47), improvements in knee-related quality of life (P<.001; ES=0.76), and improvements in the physical component of general health-related quality of life (P<.001; ES=0.74). Mean differences ranged from 6.0 to 13.2 points (scale range 0-100). ESs indicated small to medium effects. No effects were found for psychological and performance measures. Participants adhered to 92.5% (899/972) of all scheduled exercise sessions. Individuals with knee osteoarthritis undergoing a 12-week sensor-assisted app-based exercise intervention with or without an additional knee brace experienced clinically meaningful treatment effects regarding pain relief and improvements in physical function as well as other osteoarthritis-specific concerns compared to controls. German Clinical Trials Register (DRKS) DRKS00023269; https://drks.de/search/de/trial/DRKS00023269.

Evolution of treatment for unspecific back pain: From past to future.

Unspecific back pain (UBP) has long puzzled medical professionals. Historically, back pain (BP) was often attributed to mystical causes, treated with incantations or herbal concoctions. The Middle Ages shifted towards empirical practices, though still intertwined with superstition, using methods like leeches and bloodletting. The Renaissance introduced systematic healthcare approaches, laying the foundation for modern medicine. The 20th century saw significant advancements with diagnostic imaging, pharmacotherapy, physical therapy, and surgical interventions, though UBP remained elusive. Recent decades have seen a paradigm shift towards multidisciplinary approaches, addressing BP's multifactorial nature through holistic methods considering biomechanical, psychosocial, and lifestyle factors. This shift integrates quantitative research with hermeneutic interpretation, emphasizing evidence-based guidelines. Non-pharmacological interventions such as exercise therapy, electrotherapy, cognitive behavioral therapy, and mindfulness-based stress reduction have gained prominence, empowering individuals in their recovery. Technological innovations like virtual reality and artificial intelligence offer personalized treatment plans, optimizing outcomes. The future of BP treatment holds promise with advancements in regenerative medicine, neuromodulation, telemedicine, and remote monitoring platforms, enhancing accessibility and continuity of care, especially in underserved communities. However, challenges such as the opioid epidemic and healthcare disparities remain, necessitating judicious prescribing practices and equitable resource distribution. The evolving treatment landscape for UBP reflects the dynamic interplay between scientific progress, clinical innovation, and societal needs, aiming to alleviate the burden of back pain and improve quality of life.

Effects of Physiotherapy Interventions (Exercise Therapy and Electrotherapy) on Knee Osteoarthritis in Patients with Different Pain Intensity Categories

Effects of Physiotherapy Interventions (Exercise Therapy and Electrotherapy) on Knee Osteoarthritis in Patients with Different Pain Intensity Categories

Association between Flexibility, Measured with the Back-Scratch Test, and the Odds of Oxytocin Administration during Labour and Caesarean Section.

Objective: This study explored whether assessing flexibility levels in clinical settings might predict the odds of oxytocin administration and caesarean section to stimulate labour. Methods: Pregnant women from the GESTAFIT Project (n = 157), participated in this longitudinal study. Maternal upper-body flexibility was assessed at 16 gestational weeks (g.w.) through the Back-scratch test. Clinical data, including oxytocin administration and type of birth, were registered from obstetric medical records. Results: Pregnant women who required oxytocin administration or had caesarean sections showed lower flexibility scores (p < 0.05 and p < 0.01, respectively). The receiver operating characteristic curve analysis showed that the Back-scratch test was able to detect the need for oxytocin administration ((area under the curve [AUC] = 0.672 (95% confidence interval [CI]: 0.682 (95% CI: 0.59-0.78, p = 0.001)). The AUC to establish the ability of flexibility to discriminate between vaginal and caesarean section births was 0.672 (95% CI: 0.60-0.77, p = 0.002). A Back-scratch test worse than 4 centimetres was associated with a ~5 times greater increased odds ratio of requiring exogenous oxytocin administration (95% CI: 2.0-11.6, p = 0.001) and a ~4 times greater increased odds ratio of having a caesarean section (95% CI: 1.7-10.2, p = 0.002). Conclusions: These findings suggest that lower flexibility levels at the 16th g.w. discriminates between pregnant women who will require oxytocin and those who will not, and those with a greater risk of a caesarean section than those with a vaginal birth. Pregnant women below the proposed Back-scratch test cut-offs at 16th g.w. might specifically benefit from physical therapies that include flexibility training.